C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.

Objective To evaluate whether a computer-aided diagnosis (CAD) system improves interobserver agreement in the interpretation of lung nodules at low-dose CT screening for lung cancer. Materials and Methods Baseline low-dose screening CT examinations from 134 participants enrolled in the National Lung Screening Trial were reviewed by seven chest radiologists. All participants consented to the use of their de-identified images for research purposes. Screening results were classified as positive when noncalcified nodules larger than 4 mm in diameter were present. Follow-up evaluation was recommended according to the nodule diameter: ≤ 4 mm; >4–8 mm; > 8 mm. When multiple nodules were present, recommendations were based on the largest nodule. Readers initially assessed the nodule presence visually and measured the average nodule diameter manually. Revision of their decisions after reviewing the CAD marks and size measurement was allowed. Interobserver agreement evaluated using multirater κ statistics was compared between initial assessment and that with CAD. Results Multirater κ values for the positivity of the screening results and follow-up recommendations were improved from moderate (κ=0.53; 0.54) at initial assessment to good (κ=0.66; 0.67) after reviewing CAD results. The average percentage of agreement between reader pairs on the positivity of screening results and follow-up recommendations per case was also increased from 77% and 72% at initial assessment to 84% and 80% with CAD. Conclusion CAD may improve the reader agreement on the positivity of screening results and follow-up recommendations in the assessment of low-dose screening CT.

The brachiocephalic vein is formed by the internal jugular vein and the subclavian vein. The left brachiocephalic vein (LBCV) usually passes superior and anterior to the aortic arch (1). In rare cases, this vein follows an anomalous course. This anomaly was first described by Kerschner in 1888 (2) and a double LBCV described by Takata in 1992 (3). The incidence of an aberrant left brachiocephalic vein (ALBCV) with congenital heart disease is 0.15-0.98%, whereas in the general population, the incidence of this condition has been reported to be from 0.06 to 0.37% (4). In this report, we describe the computed tomography (CT) findings of circumaortic LBCV. Case ReportA 53-year-old male presented with chest wall pain. He underwent chest CT scan with 5-mm section thicknesses using a multidetector CT scanner (Aquilion 64, Toshiba Medical Systems, Tokyo, Japan). The images were acquired within a single breath hold after injection of the contrast medium (Iobrix 350; injection rate, 2.2 mL/sec; volume, 100 mL).The CT scan revealed lung cancer in the right upper lobe. Incidentally, the CT identified an ALBCV that was divided into two branches at the level of the aortic arch (Fig. 1). The anterior branch was above the aortic arch and coursed anterior to the left common carotid artery and brachiocephalic artery, before draining into the superior vena cava (SVC). The posterior branch was below the aortic arch and coursed posterior to the ascending aorta. Both branches drained into the SVC separately and no other cardiovascular anomaly was noted. The patient refused further evaluation and operation. DiscussionThe brachiocephalic veins are two large vessels at the junction of the neck and thorax, which result from union of the internal jugular and subclavian veins in the

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